BackgroundAdolescents especially females in rural area are vulnerable to a wide range of reproductive health problems including sexually transmitted infections, unwanted pregnancies, and unsafe abortion. They have limited access to reproductive health services that focus on the special needs of female adolescents. This study was aimed to assess the determinants of reproductive health service utilization among rural female adolescents of Asgede-Tsimbla district.MethodsA community-based cross-sectional study was carried out from February to April 2018, in eight randomly selected sub-districts of Asgede-Tsimbla. A total of 844 female adolescents aged 15–19 were interviewed using a pre-tested structured questionnaire. Data were entered into Epi-info Version 3.5.3 and then exported to SPSS Version 21 for analysis. Bivariate and multivariate logistic regression analysis was carried out to assess the association. Statistical significance was declared by 95% confidence interval of the odds ratio.ResultFrom 844 participants, 95.5% of female adolescents heard about reproductive services from different sources and 69.7% of them utilized the reproductive health services within the last 12 months. Factors like, age of 16–20 years (AOR = 1.85, 95%CI: 1.17–2.92), mother’s educational status (being illiterate (AOR = .33, 95%CI:.14–.77)), discussion about reproductive health services with their family (AOR = 8.02, 9%CI:5.52–11.66), being Merchant (AOR = 2.7995%CI:1.11–6.96), unemployed (AOR = 2.90, 95%CI:1.19–7.06) or student (AOR:2.38, 95%CI:1.04–5.42) in occupation, high perceived severity (AOR = 4.05, 95%CI:2.68–6.11), high perceived barriers (AOR = .44, 95%CI:.30–64) were independent predictors of reproductive health services utilization among female adolescents the study area.ConclusionAbout 69.7% of the adolescent females were utilizing reproductive health services in the study area though it was very low as compared with the national plan. Introducing messages that increase the perceived threat and decreasing perceived barriers to utilize reproductive health services as well as increasing self-efficacy of adolescent females would help further increase reproductive health services utilization by adolescent females.